Cirrhosis

“ When the liver is lessened in size in consequence of the compression exercised by the contracting exudation of a local peritonitis, there is a history of pain and soreness of the right hypochondrium, followed by the symptoms of contraction—a very different history from that of cirrhosis, in which the local attacks of pain and distress succeed to or accompany the symptoms of contraction. Occlusion of the gall-ducts by a calculus may set up a slow atrophy having some points of resemblance to cirrhosis ”

“ Occasionally, the occurrence of thrombosis of the portal vein adds an embarrassing and dangerous complication. The liver, besides the change due to cirrhosis, may be affected by amyloid or fatty degeneration, or by both combined. It should not be forgotten that more or less fatty change takes place in the hepatic cells undergoing atrophy, whence the appearance called cirrhosis. Sclerosis may be a general condition in which several organs participate, the kidneys notably. These organs are changed by a hyperplasia of the connective tissue, and especially by fatty degeneration of the epithelium. ”

“ Definition.—An accumulation of serous fluid in the peritoneal cavity.
Etiology.—Any obstruction of the portal circulation is a possible cause of ascites, the most frequent being cirrhosis of the liver. Pressure from tumors or neighboring organs may also give rise to it. Peritonitis and valvular diseases of the heart are also responsible for ascites, and chronic pulmonary affections may impair the portal circulation to the extent of producing it. ”

“ It is true, in advanced cases of cirrhosis, when the interlobular veins are obliterated by the pressure of the contracting newly-formed connective tissue, the functions of the liver are arrested in so far as the damage thus caused extends. Notwithstanding the blocking of the portal, sufficient blood reaches the hepatic cells by the anastomosis between the hepatic artery and the interlobular veins—an anatomical connection demonstrated by Cohnheim and Litten.209 So long as this anastomosis continues bile will be formed, although the portal vein is occluded. ”

“ When a prolonged course of excesses in alcohol has led to chronic congestion with hypertrophy, cirrhosis, or other structural change in the liver which is capable of causing permanent mechanical obstruction of the portal circulation, hemorrhoids constitute a very common affection in the group of morbid entities secondary to these conditions. ”

“ The temperature-curve lacks the characters of pneumonia of the ordinary form. Not seldom is febrile movement absent altogether.
The view that alcohol, independently of and in the absence of other lesions, occasionally produces changes in the lungs analogous to the chronic interstitial inflammatory processes of cirrhosis of the liver—i.e. fibroid phthisis—is not borne out by clinical or pathological investigation, and appears to be wholly without foundation in fact. ”

“ PHYSICIANS' TREATMENT for Ascites.—First treat the disease causing it. Sometimes it is necessary in order to prolong life to repeatedly tap the patient as in cirrhosis of the liver. When it is caused by the heart or kidneys, give cathartics that carry away much liquid, hydragogue cathartics. One dram of jalap at night followed by a big dose of salts before breakfast. Cream of tartar and salts are good, equal parts. Or cream of tartar alone, one to two drams, with lemon juice in water in repeated doses. Digitalis and squill, of each one grain to cause great flow of urine. ”

“ Treatment will follow the same line as in the horse. Green food, pasturage, open air life, saline laxatives, and alkalies with a free use of potassium iodide to check the sclerosis will be indicated.
506 CIRRHOSIS IN THE DOG. In the dog, cirrhosis is much more common than in the larger animals, in connection with idle pampered habits, the frequency of diseased heart and consequent disturbance of the circulation, and the presence of parasites in the liver or biliary ducts. Bacteria intoxication and infection are also common. ”

“ We cause it to produce urea from the excess of uric acid which it contains.”
“By the judicious and harmonious combination of the beneficial effects of Filudine and Urodonal, physicians not only possess the means of treating by rational methods Cirrhosis of the Liver in its various forms (which is one of the most terrible diseases which can afflict anyone) but what is still better, they can cure it.” ”

“ The feet and genital organs may be oedematous (watery swelling) , jaundice is slight and does not occur until late. During the late stage the patient is much shrunken, face is hollow, the blood vessels of the nose and cheeks are dilated, abdomen is greatly distended. Delirium, stupor, coma or convulsions may occur at any time.
[132 MOTHERS' REMEDIES] PHYSICIANS' TREATMENT for Cirrhosis of the Liver.—It is usually fatal; sometimes even after temporary improvements. No coffee or alcohol; simple diet, bitter tonics, keep bowels open, A physician must handle such a case. ”

“ Lesions: nutmeg liver, degeneration, cirrhosis. Symptoms: pampered idleness, obesity, pulmonary or cardiac disease, intestinal catarrh, piles, ascites, slight icterus, percussion tenderness of right hypochondrium, lying on right side, increase of percussion flatness. Treatment: saline purgatives or laxatives, antiseptics, restricted laxative diet, open air exercise, derivatives, etc.
Physiologically the liver undergoes hyperæmia in connection with an abundant meal and active digestion. Within the limits of health it may increase one-third in bulk and weight. ”

“ Fatty cirrhosis is often found in post-mortems. The first symptoms are the same as those accompanying chronic gastritis, dyspepsia, They are:—Appetite is poor, nausea, retching and vomiting, especially in the morning; distress in the region of the stomach, constipation or diarrhea. These increase and vomiting of blood from the stomach may occur early and late. Bleeding from the stomach and bowels, etc., cause the stools to look like tar. Nosebleed and piles are common and profuse; bleeding may cause severe lack of blood. ”

“ The coagulability of the blood is increased in diseases characterized by an excess of its fibrin-producing constituents, of which cirrhosis of the liver may be mentioned as one having this peculiarity. ”

“ Emaciation is also a prominent symptom. No affection, not even diabetes or phthisis, produces loss of flesh so rapid, so marked, and so significant as cirrhosis of the liver in chronic alcoholism. Not only do the adipose tissues waste, but the muscles themselves undergo rapid atrophy. This fact is not surprising when we consider that the lesions of the liver give rise to grave interference with every function of that organ. In addition to the more common gastric symptoms, there is constipation, not rarely alternating, without assignable cause, with serous and sometimes bloody diarrhœa. ”

“ When the cells are destroyed, their remains may be discerned in the mass of connective tissue as fine fat-granules or masses of pigment yellowish or brownish in color. The peculiar appearance to which the name cirrhosis is applied is due to the lobules or groups of lobules which project on section above the divided surface, and are colored yellowish by the bile-pigment, which here exists in an exaggerated quantity. The cells themselves are not normal: they are enlarged by compensatory hypertrophy, and they contain much bile-pigment and a considerable quantity of fat. ”

“ Very often the syphilitic cachexia coincides with alcoholic excess. There can be no doubt that chronic malarial poisoning causes, or powerfully predisposes to, cirrhosis. I have submitted elsewhere pathological evidence on this point,59 and the Italian physicians, who have the opportunity to obtain accurate data, maintain that malarial toxæmia does bring about this state. It is probable that the overgrowth of connective tissue is induced by the repeated congestions of the malarial attacks, and by the obstruction due to catarrh of the bile-ducts which so often occurs in the febrile paroxysms. ”

“ The development of pathology has shown us that once there has been serious nephritis or cirrhosis of the liver certain portions of the glands are destroyed and therefore there cannot be any question of cure. There is no possibility of redintegration of destroyed tissues when they are of highly organized character, and so the patient will always be maimed. One might as well talk of causing an amputated finger to grow again as talk of curing diseases that involve destruction of specialized cells. ”

“ Any fully-developed case of cirrhosis can only terminate in one way, for we possess no means of restoring the hepatic cells when once destroyed. At the outset of the disease, before any serious changes have taken place, it is probable it may be arrested. ”

“ Proceeding to its natural termination without complications or intercurrent affections, death finally occurs from exhaustion. The emaciation becomes extreme, the stomach gets to be excessively irritable, and an exhausting diarrhoea consumes the last remains of strength. Then an oedema of the lungs or failure of the heart or a deep coma ends the scene.
DIAGNOSIS.—Cirrhosis in its first stage is to be distinguished from diseases which cause enlargement of the liver, and in its second or contracting stage from diseases that induce contraction of the organ. ”

“ Notwithstanding the familiarity of medical men with the fact that many cases of hepatitis, chronically enlarged liver, and cirrhosis are directly traceable to inebriety, few, I fancy, can have been prepared, without some special acquaintance with, the subject, for the information furnished, by the foregoing mortality tables of the potent action of alcohol on the liver, when only taken in small quantities at a time. ”

“ Epilepsies and cirrhosis livers are like wise very frequent, owing, as is supposed, to their defeating or diminishing perspiration, or stopping the pores by constant unction, as also by the quantity of water they deluge themselves with at the time they are hottest. ”

“ They are, however, of little or no use if the enlargement of the liver is caused by some kinds of tumours, such as cancer, encysted abscess, ascarides, tubercles, &c., or if there is an atrophy of this organ, called cirrhosis. They often cure jaundice in its many forms; also biliousness; gall-stones; some tumours of the spleen and of the mesenteric glands; some forms of dropsy; obesity; stones in the bladder and kidneys, principally when caused by uric acid; diabetes ”

“ Liver disorders affect thousands of American children from infancy to adolescence. More than 100 different types of liver diseases, which attack these young people, have been identified. These diseases can be inherited or acquired from infection, poisons, injury, or such diseases as cystic fibrosis, anemia, leukemia, kidney or intestinal disease and glandular disorders. Infants can be born with a damaged liver or with biliary atresia, a disease characterized by abnormally-formed bile ducts. Some disorders can result in cirrhosis of the liver. ”

“ The pelvic veins do not readily discharge their blood by the natural channels, and by anastomosing branches it is forced over the surface of the abdomen and into the thoracic veins, these latter becoming in turn greatly enlarged. The appetite is commonly poor, the digestion flatulent, the pulse accelerated. Emaciation is gradual or rapid. The urine is commonly scanty, and in cirrhosis of a reddish hue. The skin is apt to be dry, particularly so in simple chronic peritonitis. The tongue has no characteristic fur, and is often, almost always toward the close, dry. ”

“ It is typically a disease of people of alcoholic habit. It occurs in those who are engaged in the sale of spirits, though the alcoholic absorption does not take place {157} through the skin, but in a much more direct way. It is most frequent in people who take strong spirits on an empty stomach. Those who are much exposed to changes of temperature are especially liable to form such habits. It is found most frequently in the drivers of wagons and cars, in policemen, and in sea-captains, sailors, and the like. When cirrhosis causes sudden death, it is nearly always by hemorrhage. ”

“ Hepatic enlargement to 20 or 30 pounds, and dark red color, darker spots of extravasation, hepatic vein congestion in centre, and portal vein congestion in periphery of acinus, softening, granular, fatty, nuclei disappear from hepatic cells, nutmeg liver, cirrhosis. Symptoms: general febrile symptoms, great prostration, drowsiness, slight colics, arched loins, trembling or jerking, lies on right side, percussion on last ribs painful, slight icterus and increased urination and urea. In passive cases, less icterus and kidney trouble; tends to intestinal catarrh and ascites. ”

“ In catarrhal jaundice it is in most cases the bowel that is at fault, the liver acting properly, but unable to get rid of all the bile produced. The liver suffers, however, from several diseases of its own. Its fibrous or connective tissue is very apt to increase at the expense of the cellular elements, destroying their functions. This cirrhotic process usually follows long-continued irritation, such as is produced by too much alcohol absorbed from the bowel habitually, the organ gradually becoming harder in texture and smaller in bulk. ”

“ Thus a stone at the neck of the bladder, if its stimulus is not very great, only induces the pain of strangury at the glans penis. If its stimulus be greater, it then induces pain at the neck of the bladder. The concretions of bile, which are protruded into the neck of the gall-bladder, when the disease is not very great, produce pain at the other extremity of the bile-duct, which enters the duodenum immediately under the pit of the stomach; but, when the disease is great from the largeness of the bile-stone, the pain is felt in the region of the liver at the neck of the gall-bladder. ”